Abstract Background Sustainable models of inflammatory bowel disease (IBD) care require an understanding of how chronic therapeutic choices contribute to environmental impacts. However, evidence for quantifying the carbon footprint associated with modern IBD therapies remains limited. This study evaluated the environmental burden of long-term treatment pathways in a large real-world cohort 1. Methods This retrospective analysis included 1,000 consecutive adults with Crohn’s disease or ulcerative colitis who were followed at a tertiary center between 2020 and 2025. The patients were stratified into five treatment groups: conventional therapies, anti-TNF agents, vedolizumab, ustekinumab and JAK inhibitors. Annual carbon emissions were calculated using literature-derived carbon dioxide equivalent (CO2e) coefficients encompassing drug manufacturing, healthcare utilisation (endoscopy, outpatient visits, infusion sessions) and patient travel 2. Multivariable linear regression adjusted for age, sex and disease type identified independent predictors of yearly CO2e, including treatment class and healthcare utilization parameters. The emission profiles across treatment classes are illustrated in Figure 1. Results The cohort reflected diverse treatment patterns: 350 patients received conventional therapy, 360 received anti-TNF agents, 110 received vedolizumab, 120 received ustekinumab and 60 JAK inhibitors. Annual CO2e differed markedly between the treatment groups; infusion-based anti-TNF (300 kg) and vedolizumab (280 kg) regimens had the highest emissions, whereas JAK inhibitors showed the lowest (60 kg; p 0.001). Ustekinumab produces intermediate emissions (180 kg). In multivariable analysis, annual endoscopy frequency was the strongest independent predictor of CO2e (p 0.001), followed by overall healthcare utilization (p 0.01) 3. Treatment class remained an independent determinant, with anti-TNF and vedolizumab associated with the highest adjusted CO2e and JAK inhibitors, with the lowest (p 0.001). Crohn’s disease was linked to slightly higher adjusted emissions than ulcerative colitis, whereas age and sex were not significant predictors. Conclusion Long-term IBD treatment strategies differ substantially in their environmental footprint. Infusion-based biologics and high-intensity healthcare utilization are key drivers of carbon emissions, whereas JAK inhibitors have a lower-emission profile 4. These findings support the integration of environmental considerations into sustainable IBD care. References: 1. Tennison I, Roschnik S, Ashby B, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS. Lancet Planet Health. 2021;5(2):e84-e92. 2. Rizan C, Reed M, Bhutta MF. Environmental impact of healthcare: a systematic review. J Clean Prod. 2021;280:124–131. 3. Pisani LF, Tontini GE, Vecchi M. Environmental burden of endoscopic procedures in IBD care. Clin Gastroenterol Hepatol. 2022;20(9):e1623-e1632. 4. Kotze PG, Steinwurz F, Dulai PS, et al. Modern therapy pathways and sustainability in IBD care. Lancet Gastroenterol Hepatol. 2023;8(4):321-330. Conflict of interest: Dr. Özden, Yavuz: Grants: No – The author has received no grants. Personal Fees: No – The author has received no personal fees. Consulting: No – The author has not provided consulting services. Support for travel for meetings to support study: No – The author has received no travel support. Shareholder: No – The author holds no relevant shares. Fees for participation in review activities (data monitoring boards, statistical analysis, endpoint committees, etc.): No – The author has not participated in any paid review activities. Payment for writing or reviewing the manuscript: No – The author has received no payment for writing or reviewing. Non-financial support: No – The author has received no non-financial support. Provision of writing assistance, medicines, equipment, or administrative support: No – The author has received no such support. Other: No – No other conflicts of interest are present. The author declares no conflicts of interest.
Y Özden (Thu,) studied this question.